Get Involved: Endorsement Form

Endorsement Form for the Mother-Friendly Childbirth Initiative

The Mother-Friendly Childbirth Initiative (MFCI) is the nation’s first and only consensus document which defines the ten specific steps a maternity care service or birthing facility can take to provide evidence-based, mother- and baby-centered maternity care. Help Make Mother-Friendly Care A Reality by adding your name to our web site as a proud endorser of the MFCI.

Endorse the MFCI Today [PDF] or use the form below:

I/We endorse the MFCI as:*

Organizations must have board approval to endorse.
an individual
an organization

First Name:*

Last Name:*

Credentials/Degrees:

Your Title:

Name of Organization:*

Date of Board Approval:*

Address:*

City:*

State/Providence:*

Zip:*

Country:*

Telephone:*

Fax:

Email:*

Website:

Organization Affiliation (if any):

I am a:

Check all that apply
Consumer
Birth Advocate
Childbirth Educator
Lactation Consultant
Doula
Midwife
Nurse
Physician

More Info:
Please send me more information on becoming an Individual Member of CIMS.

More Info:
Please send me more information on becoming an Annual Organizational Member of CIMS.

*Please Initial -- I have read and want to add my name or my organization's name as an endorser of the Mother-Friendly Childbirth Initiative.

Links

Downloads

Download and print the PDF version of this form and mail or fax it to:

Coalition for Improving Maternity Services
1500 Sunday Drive, Suite 102
Raleigh, NC 27607
Telephone: 919.863.9482
Fax 904-285-2120